User perspectives on the usability of a regional health information exchange

OBJECTIVE We assessed the usability of a health information exchange (HIE) in a densely populated metropolitan region. This grant-funded HIE had been deployed rapidly to address the imminent needs of the patient population and the need to draw wider participation from regional entities. DESIGN We conducted a cross-sectional survey of individuals given access to the HIE at participating organizations and examined some of the usability and usage factors related to the technology acceptance model. MEASUREMENTS We probed user perceptions using the Questionnaire for User Interaction Satisfaction, an author-generated Trust scale, and user characteristic questions (eg, age, weekly system usage time). RESULTS Overall, users viewed the system favorably (ratings for all usability items were greater than neutral (one-sample Wilcoxon test, p<0.0014, Bonferroni-corrected for 35 tests). System usage was regressed on usability, trust, and demographic and user characteristic factors. Three usability factors were positively predictive of system usage: overall reactions (p<0 0.01), learning (p<0.05), and system functionality (p<0.01). Although trust is an important component in collaborative relationships, we did not find that user trust of other participating healthcare entities was significantly predictive of usage. An analysis of respondents' comments revealed ways to improve the HIE. CONCLUSION We used a rapid deployment model to develop an HIE and found that perceptions of system usability were positive. We also found that system usage was predicted well by some aspects of usability. Results from this study suggest that a rapid development approach may serve as a viable model for developing usable HIEs serving communities with limited resources.

[1]  P. Harris,et al.  Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support , 2009, J. Biomed. Informatics.

[2]  Kent L. Norman,et al.  Questionnaire Administration Via the WWW: A Validation & Reliability Study for a User Satisfaction Questionnaire , 1997, WebNet.

[3]  Kent L. Norman,et al.  Development of an instrument measuring user satisfaction of the human-computer interface , 1988, CHI '88.

[4]  Mark E Frisse,et al.  State and community-based efforts to foster interoperability. , 2005, Health affairs.

[5]  Kevin B. Johnson,et al.  A Regional Health Information Exchange: Architecture and Implementation , 2008, AMIA.

[6]  Viswanath Venkatesh,et al.  Why Don't Men Ever Stop to Ask for Directions? Gender, Social Influence, and Their Role in Technology Acceptance and Usage Behavior , 2000, MIS Q..

[7]  Joshua R. Vest,et al.  Factors motivating and affecting health information exchange usage , 2011, J. Am. Medical Informatics Assoc..

[8]  J. Marc Overhage,et al.  Community Clinical Data Exchange for Emergency Medicine Patients , 2003, AMIA.

[9]  Douglas J Gould,et al.  A usability study of users' perceptions toward a multimedia computer‐assisted learning tool for neuroanatomy , 2008, Anatomical sciences education.

[10]  Po-Hsun Cheng,et al.  The strategic use of standardized information exchange technology in a university health system. , 2010, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[11]  Kevin B. Johnson,et al.  Playing smallball: Approaches to evaluating pilot health information exchange systems , 2007, J. Biomed. Informatics.

[12]  T. Landauer,et al.  Handbook of Human-Computer Interaction , 1997 .

[13]  Clay Shirky,et al.  A tale of three cities--where RHIOS meet the NHIN. , 2006, Journal of healthcare information management : JHIM.

[14]  I. Sim,et al.  Physicians' use of electronic medical records: barriers and solutions. , 2004, Health affairs.

[15]  J. Nunnally,et al.  Psychometric Theory: NY. , 1978 .

[16]  J G Anderson,et al.  Evaluating the Impact of Health Care Information Systems , 1997, International Journal of Technology Assessment in Health Care.

[17]  M. Välimäki,et al.  Barriers and facilitators influencing the implementation of an interactive Internet-portal application for patient education in psychiatric hospitals. , 2008, Patient education and counseling.

[18]  V. Venkatesh,et al.  AGE DIFFERENCES IN TECHNOLOGY ADOPTION DECISIONS: IMPLICATIONS FOR A CHANGING WORK FORCE , 2000 .

[19]  Thomas K. Landauer,et al.  Research Methods in Human-Computer Interaction , 1988 .

[20]  Julia E. W. C. van Gemert-Pijnen,et al.  Factors affecting health care workers' adoption of a website with infection control guidelines , 2009, Int. J. Medical Informatics.

[21]  Detmar W. Straub,et al.  Trust and TAM in Online Shopping: An Integrated Model , 2003, MIS Q..

[22]  David W. Bates,et al.  Viewpoint Paper: E-Prescribing Collaboration in Massachusetts: Early Experiences from Regional Prescribing Projects , 2006, J. Am. Medical Informatics Assoc..

[23]  Fred D. Davis,et al.  User Acceptance of Computer Technology: A Comparison of Two Theoretical Models , 1989 .

[24]  Fred D. Davis.  Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology , 1989, MIS Q..

[25]  G. Kuperman,et al.  Approaches to patient health information exchange and their impact on emergency medicine. , 2006, Annals of emergency medicine.

[26]  Patrick Royston,et al.  Multiple Imputation of Missing Values: Further Update of Ice, with an Emphasis on Categorical Variables , 2009 .

[27]  J. Jacoby,et al.  Is There an Optimal Number of Alternatives for Likert Scale Items? Study I: Reliability and Validity , 1971 .

[28]  Richard E. Boyatzis,et al.  Transforming Qualitative Information: Thematic Analysis and Code Development , 1998 .

[29]  Charlene R. Weir,et al.  Does user satisfaction relate to adoption behavior?: an exploratory analysis using CPRS implementation , 2000, AMIA.

[30]  Robert H. Miller,et al.  The Santa Barbara County Care Data Exchange: what happened? , 2007, Health affairs.

[31]  K. B. Johnson.  Barriers that impede the adoption of pediatric information technology. , 2001, Archives of pediatrics & adolescent medicine.

[32]  Peter A. Todd,et al.  Perceived Usefulness, Ease of Use, and Usage of Information Technology: A Replication , 1992, MIS Q..